Like many physicians, Michael A. Olympio, MD, recognizes that current methods to exchange endotracheal tubes, life-saving devices used to initiate mechanical ventilation, are limited in their visual scope, stability, ease of exchange and degree of safety.
So 10 years ago, Olympio, Professor of Neuroanesthesiology in the Departments of Anesthesiology and Urology at Wake Forest Baptist Medical Center, started searching for a safer, more effective way to perform this procedure. His efforts resulted in the endotracheal tube exchanger – a device with the potential to revolutionize the speed and safety with which patients’ tubes are exchanged.
Olympio led a research project with his colleagues that he named ‘FACETTE’ (fiberoptic assisted coaxial endotracheal tube exchange), exploring a new endotracheal tube exchange technique.
Using a scalpel blade, hemostat and a toothed clamp in the simulation lab at Wake Forest Baptist Medical Center, they performed this exchange. The procedure allowed the physicians to slice the existing endotracheal tube away from the fiberoptic scope, and then slide in the new, pre-loaded endotracheal tube over the same fiberoptic scope without losing site of the carina within the airway.
Years later, the method previously explored in the simulation lab became a life-saving procedure, and the impetus to create a device to better perform endotracheal tube exchange.
While treating one of his trauma patients with severe head and neck injuries, Olympio encountered a defective endotracheal tube that required immediate exchange. He didn’t want to lose sight or stability of the airway with a standard endotracheal tube exchanger, so he quickly performed the exchange according to his FACETTE experience, with a successful outcome.
Although this procedure had been reported years earlier by Hudes, Fisher and Guslitz in a paper titled “Difficult Endotracheal Reintubations: A simple technique” (Anesthesiology 1986;64:515-17), there was not a tool to perform the technique, so Olympio set out to invent a device.
The Endotracheal Tube Exchanger
Working with the team at Wake Forest Innovations, Olympio advanced his creation of the endotracheal tube exchanger. Used in conjunction with a fiber optic bronchoscope, the device allows the physician to maintain direct visualization of the internal airway as the old tube is cut and removed, allowing the new endotracheal tube to slide into place quickly and accurately. It is disposable and includes a slicing tool and oral stabilizer that securely fastens the fiber optic scope and protects the patient’s mouth during tube exchange.
The benefits of the device are numerous, including: direct visualization maintained throughout tube placement; easy, stable and quick tube exchange; user-friendly; disposable and inexpensive to produce.
“This device will make tube exchange simpler, faster and more assured — which is a win-win for physicians and patients,” Olympio said. “It has significant market potential to become the leading instrument to facilitate changing tubes whenever necessary in any ventilated patient.”